| NPI | 1376695361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NY N003426) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NJ MD01710) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-07-08 |